8/3/2019 New Visa Application Form for MVV

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0BUZ00063|E

Application form for MVVThis application form is free of charge

1 Personal

1.1 Surname(familyname)

1.2 Surnameatbirth

(previousfamilyname)

1. Firstname(s)(givenname(s))

1.4 Dateofbirth

1.5 Placeofbirth

1.6 Nationality

1.7 Sex

1.8 Maritalstatus

1.9 Homeaddress

1.10Telephonenumbers

1.11E-mailaddress

1.12 Incaseofminorsdetailsof

parentalauthority/legalguardian

1.13 Residenceinacountryother

thanthecountryofcurrentnationality

Passportphoto

size5by45mm

(widthbyheight)

|

|

|

Day month year

Place Country

| |

Currentnationality Nationalityatbirth

| |

Male Female

Single Married Separated Divorced

Widow(er) Other, please specify

|

| |

|

Surname Firstname

| |

Address Nationality

| |

No. Validuntil

No Yes.Residencepermitorequivalent | |

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8/3/2019 New Visa Application Form for MVV

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2van2

1.14Typeoftraveldocument

1.15Passportdetails

2 PurposeofstayintheNetherlands2.1 Employment

2.2 Family

2. Study/exchange/workplacement

2.4 Other

2.5 Intendeddateofarrival

intheNetherlands

2. Nameandaddressofyour

hostintheNetherlands

2.7 Hasyourhoststartedthemvv-procedureforyouwithINDintheNetherlands

2.8 Ifnot,whowillpaythe

mvv-feesintotheDutch

bankaccountofIND

2.9 IsyourhostanEU,EEAorSwisscitizen,livingin

theNetherlands,not a Dutch citizen

3 Signature

.1 Placeanddate

.2 Signature

> For minors signatureof parental authority/legal guardian

Ordinarypassport Diplomaticpassport Servicepassport Ocialpassport

Specialpassport Othertraveldocument,please specify

Passportnumber Dateofissue

|

Validuntil Issuedby

|

Paidemployment Selfemployment Highlyskilledmigrant

Highlyeducatedmigrant Leave in theNether lands,worker on North Sea drilling platforms

Joinspouseorregisteredpartner Joinpartner Joinparents

Joinfosterparents Joinachild,single parent of 65 years or older

Joinadoptiveparents Visitingrelatives,max. 6 months

Extendedfamilyreunication,children over 18 years

Study Culturalexchange,highschool students

Workplacement Workingholidayprogramme/scheme,Australia, Canada, New Zealand

Aupair Medicaltreatment Specialgrounds

ReadmissiontotheNetherlands,lived in the Netherlands before Reselementofaninvitedrefugee

Day month year

Name

|

Address

|

Yes No

Myhostwillpaythe fees Iwillpaythe feesmyself

Yes No

Place Day month year

|

|

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